PILATES AND PREGNANCY: safe AB exercises
By Debbi Goodman, MSPT
Debbi Goodman, MSPT is a licensed manual physical therapist with specialties in women’s health,
dance medicine and sports medicine. She has been a physical therapist for Westside Dance
Physical Therapy, New York City Ballet, School of American Ballet and the Kane School of Core
Integration. Debbi has had a private women’s health/orthopedic practice in New York City, and
since moving to the Albany area in 2004, she has developed a private practice in the Capital
District. Debbi is one of the few physical therapists trained in internal evaluation and treatment of
the pelvic floor muscles. In addition, she is specifically skilled in treatment of pregnancy problems
including: sciatica, back/neck pain, pelvic pain and rib pain, and postpartum problems including:
cesarean section recovery, urinary incontinence, pelvic/vaginal pain and post-delivery scars. Debbi
also teaches continuing education workshops for physical therapists, trainers and Pilates
instructors focusing on educating professionals on exercise during pregnancy, and she is an
instructor for prenatal and postpartum group fitness classes.
Pilates is a wonderful form of exercise for pregnant women. Through Pilates, women can stay
strong and fit throughout their pregnancies. Pilates can help women stay connected to their
changing body, improve posture and reduce pregnancy aches and pains. However, Pilates
instructors working with this population need to be knowledgeable about the anatomical and
physiological changes that occur during pregnancy, as well as about the birth process. In addition, it
is extremely important that Pilates instructors have a clear understanding of how pregnancy affects
the abdominal muscles.
Pregnancy: A Real Ab Stretch
During the course of pregnancy, the abdominal muscles will stretch by over 50 percent of their
original length. Strengthening the abdominal muscles is critical during pregnancy to help support
the growing uterus, decrease lumbar compression and reduce pelvic pressure. Women who practice
safe abdominal strengthening during pregnancy have less low back pain, less pelvic pain, better
mobility, easier deliveries and faster recoveries.
During pregnancy, a hormone is present, called relaxin, which helps to increase laxity of all the
muscles, joints, ligaments and joint capsules. The purpose of this hormone is to increase mobility of
the tissues so that the body is able to accommodate the rapid fetal growth and prepare the body for
delivery. The abdominal muscles are most directly affected by the growing fetus and have the
ability to stretch significantly as the fetus grows.
The Diastasis Recti
At about 20 weeks and often sooner for a second pregnancy, the rectus abdominus will begin to
separate along the linea alba with the two rectus halves moving laterally. This is called a diastasis
recti.
This is a normal occurrence during pregnancy, and this will occur in almost all women. However,
when the diastasis recti occurs, there is less support for the lower back, which often results in an
increase in low back pain or other discomforts. In addition, women who do not control the size of
the diastasis may have difficulty closing it postpartum and may be at risk for an umbilical hernia,
especially if there is a subsequent pregnancy without proper closure of the separation.
Exercises to Avoid During Pregnancy
Pilates instructors working with pregnant women need to pay careful attention to making sure the
chosen exercises are appropriate for this group. Exercises that make the diastasis worse are any
movements that require the rectus abdominus to contract strongly against gravity. When the rectus
is asked to contract strongly, if the integrity of the muscle is lost, the two halves of the muscle will
shorten and contract as two separate units with each half moving laterally. This, in turn, opens the
separation further.
Precautions need to be taken during any supine exercises that involve lifting the head and shoulders
off the ground or lifting both lower extremities off the ground, as well as during plank or push-up
positions.
This means that many of the traditional abdominal exercises in the Pilates repertoire are not going
to be appropriate and may be potentially dangerous with respect to opening the diastasis. Therefore,
the Pilates instructor must be skilled in the ability to modify the program and knowledgeable about
safe choices for pregnancy. It is also valuable for Pilates instructors to have knowledge in how to
palpate a diastasis so they can screen clients who might be at risk for this abdominal muscle issue.
Safe Pregnancy Training
Safe abdominal strengthening during pregnancy should look deeper than the rectus and focus on
training of the internal obliques and the transversus abdominus (TVA). Training of the TVA is
particularly beneficial because contraction of the TVA directly supports the uterus, and a well toned
TVA will help keep the rectus halves closer together and prevent the diastasis from opening
excessively. Therefore, TVA training can reduce the size of the diastasis. In addition, training the
TVA also helps women prepare for delivery, as one of the roles of this muscle is to assist during
forceful expiration (i.e. pushing).
Training of these muscles can occur in all positions, but pregnant women are often most
comfortable in sitting and quadruped positions, especially as the pregnancy progresses.
Gentle supine abdominal exercises—such as knee folds, heel slides, pelvic tilts and head lifts—are
acceptable and are often much more challenging than one would expect as the abdominal muscles
are becoming increasingly weakened.
Basic Abdominal Program for Pregnancy
Here are some examples of basic core exercises that should be included in every pregnant woman’s
exercise program:
Seated or Quadruped Transversus Contraction
Helpful for minimizing diastasis, stabilizing spine and pelvis, and maintaining abdominal tone
during pregnancy; essential after pregnancy. Transversus is easier to contract seated or on all fours
versus lying down. Good position to begin training.
Seated Transversus: Start seated with body weight centered over pelvis and shoulders aligned over
pelvis, practice pulling belly button to the spine without allowing ribcage to shear forward.
1. 30-Second Hold: Begin with a belly breath and expand the body, then exhale and move the belly
button toward the spine. Hold it here for 30 counts. End with a belly breath.
2. Contracting Transverse: Same position as above. Inhale and expand body. Exhale all the way to
the spine, hold for one count and then repeat 50-100 reps.
Quadruped: This position is beneficial as it takes weight off the pelvic floor and helps to increase
perineum circulation.
Start on hands and knees with hands lined up with shoulders and knees lined up with hips; the spine
should be neutral. If wrists are a problem, use fists on the floor. Allow belly to sag toward floor
(without changing spine alignment), then pull belly button to spine maintaining neutral spine.
Repeat 50-100 reps.
Supine Transversus Contraction: This is the most difficult position in which to engage the
transversus due to decreased proprioception.
Start lying on the back with bent knees, feet on the floor hip-width apart. Begin exercise with a
belly breath, then exhale belly to the spine without doing a posterior pelvic tilt. Exercise can be
performed using the 30-second hold, contracting transversus, or use traditional abdominal
stabilization techniques such as knee folds while keeping the trunk stabilized.
Sample Prenatal Mat Workout
Now that you know the basics, here’s an example of safe mat exercises for pregnant women:
Saw
Spine Twist
Modified Roll-Up/Roll-Down
Mermaid
Rowing 3,4,5,6
Spine Stretch Forward
Chest Expansion
Legs Against the Wall
Modified Hundred—kneeling or supine with one leg at a time in table top
Neck Roll—seated
Swimming—hands & knees
Shoulder Bridge